Psychological and Physiological Predictors of Angina During Exercise-Induced Ischemia in Patients With Coronary Artery Disease

Abstract

Objective This study compares sensory-biological, cognitive-emotional, and cognitive-interpretational factors in predicting angina on an exercise treadmill test (ETT). Methods 163 patients with ETT-induced ischemia and coronary artery disease (CAD) in the NHLBI Psychophysiological Investigations of Myocardial Ischemia (PIMI) study were given an ETT, and 79 patients reported angina during the ETT. We assessed the following as predictors of self-reported anginal pain: sensory-biological factors (β-endorphin reactivity, hot pain threshold, and maximum ST-segment depression), cognitive-emotional factors (negative affect and symptom perception), and cognitive-interpretation (self-reported history of exercise-induced angina). Models were covariate-adjusted with predictors examined individually and as part of component blocks. Results Logistic regression revealed that history of angina (OR=17.41, 95% CI=7.16–42.34) and negative affect (OR=1.65, 95% CI=1.17–2.34), but not maximum ST-segment depression, hot pain threshold, β-endorphin reactivity, nor symptom perception were significant predictors of angina on the ETT. The component block of sensory-biological variables was not significantly predictive of anginal pain (chi2block = 5.15, p = 0.741). However, the cognitive-emotional block (chi2block = 11.19, p = 0.004) and history of angina (cognitive-interpretation) (chi2block = 54.87, p < 0.001) were predictive of ETT angina. A model including all variables revealed that only history of angina was predictive of ETT pain (OR = 16.39, p < 0.001), although negative affect approached significance (OR = 1.45, p = 0.07). Conclusion These data suggest that in patients with ischemia, cognitive-emotional and cognitive-interpretational factors are important predictors of exercise angina.

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia

“…In terms of the magnitude of our associations, our findings suggest that every 1 point increase in NA was associated with a 13% and 11% greater chance of reporting chest pain during exercise in patients with and without ischemia, respectively. These results are generally consistent with previous reports (24). Previous studies have demonstrated that NA affect measures, such as depression, are associated with greater symptom reporting in patients with and without CVD (16,17).…”

“…Previous studies have demonstrated that measures of NA, such as depression, are generally associated with greater pain symptom reporting in patients with and without CVD (16,17), as well as higher reported pain intensity in post-surgical patients (23). However, higher general NA has also been shown to predict the presence of exercise-induced angina (24). Anxiety, another measure of NA, has been linked to higher reports of chest pain among cardiac and non-cardiac populations (25,26).…”

The association between psychological distress and angina pectoris: A population-based study

“…Psychological distress through biological and behavioral pathways affects the incidence, progression, and mortality rates of many chronic illnesses, especially cardiovascular conditions [3,4], including exacerbation of the occurrence and frequency of angina pectoris (AP) symptoms [5–7]. A meta-analysis across 31 countries indicates that the prevalence of AP ranges from 0.7% to 15% in the general population [8].…”

Effect of Aerobic Exercise on Morphine Self-administration and Pain Modulation in Rats

“…[ 33 ] It has been shown that aerobic exercise stimulates the release of beta-endorphin and other endogenous opioid peptides that are believed to be responsible for the increased nociceptive threshold after training. [ 34 ] Support for these results comes from the findings of a study that showed the opioid antagonist naloxone to prevent elevated nociceptive threshold following exercise in normal volunteers[ 35 ].…”